The Gait Analysis Part-2


This is the second in a multi part series. If you missed part 1, click here.

here it’s quick review of gait cycle…There are two phases of gait: stance phase and swing phase.

Stance phase consists of:

Heel strike

Foot flat (Loading response)

Midstance
Terminal stancephase

Pre-swing

Swing phase:

initial (early) swing
mid swing
terminal (late) swing

Today we explore what’s happening during foot flat (Loading Response): 

we remember that foot flat  Loading response occurs when there is weight bearing on the loaded extremity from heel strike. This continues until the opposite foot is lifted for swing.

what is happening here at the major anatomical areas:

Foot:

Pronation begins: the coefficient of friction of the heel with the ground is great enough that pronation of the midfoot begins. As the calcaneus moves, the talus slides anteriorly and plantar flexes, adducts and everts which unlocks the subtalar joint and it is moving toward making its axis parallel with the calcaneo cuboid joint at midstance because of this motion, the calcaneus everts approximately 5°
from its main axis of rotation.

Ankle

The ankle plantar flexes 5-10 °. This motion is attenuated by eccentric action of the anterior compartment muscles of the lower leg this serves to absorb shock.

Knee:

Flexion to 15°. This is attenuated largely by the quadriceps, contracting eccentrically.


Hip:

The hip is at full flexion at loading response and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

 

referances:

  1.  A Three-dimensional Gait Analysis of People with Flat Arched Feet on an Ascending Slope -Kwon Kim, PT, PhD and Yun-Seop Lee, PT, PhD
  2. Cynthia norkins: joint structure and function
  3. The Pathokinesiology Service and the Physical Therapy Department. Observational Gait Analysis. Rancho Los Amigos National Rehabilitation Center, Downey, CA, 2001

 

 

 

Cervical Spine & Motor control : Part 2 DCNF assessment

Here is second part of cervical spine .In case you missed previous blog here is link of part 1

Before we begin I just want to reinforce that motor control is one aspect of cervical spine assessment, which includes:

  • Functional assessment
  • Observation of posture and active range of movement
  • Passive range of movement and palpation
  • Neurological assessment 
  • joint sense error and other tests for sensory motor control
  • Motor control.

The author state that “The challenge for clinicians assessing muscular deficits in the cervical region .Additionally, the physical conditioning requirements of patients presenting with mechanical neck pain are not homogenous” (O’Leary, Falla, Elliott & Jull., 2009, p.327).

 there  is no clear pattern for motor control dysfunctions nor set criteria for normal strength .Therefore, it is important to identify during the subjective examination what patient functional requirements.

It is necessary to observe patient functional task before you begin trying to quantify the motor control strategies. “The observation of dynamic postural control of the cervical spine is not usually directly quantifiable.  (O’Leary, Falla 2008)

you should keep in mind while observation  at spinal postural.

  1. How the axio-scapular muscles are functioning.
  2. what the scapulohumeral position?
  3. How this changes between weight bearing and not weight bearing positions. 
  4. When observing movement and posture, there is always challenge for the clinicians to link any abnormalities seen to the patient’s neck pain.

ASSESSMENT FOR DEEP NECK FLEXORS:

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It is very difficult for deep cervical neck muscles observe and palpate. In 2005, Falla, Jull, O’Leary and Dall’Alba demonstrated that using a nasopharyngeal approach to position EMG electrodes over the posterior oropharyngeal wall was a reliable way to evaluate the function of these muscles without risking injury related to previously used open anterior approach. 

ASSESSMENT PROCEDURE……

It is important to screen the craniocervical flexion motion before beginning the test. It’s not strength assessment but the precision and control of muscles.

  • The test is performed in  crook lying and a towel folded and placed under the patient’s head, so their face is horizontally level.
  • The towel is placed under the occiput only to allow for the pressure biofeedback unit (PBFU)to be placed under the patient’s neck.
  • PFBU is inflated to 20mmHg.
  • They should perform a head-nodding movement as if saying ‘yes’ and feel their head slide gently up the towel.

Test 1:

  • The first aim is to move the pressure dial from 20-22mmHg. This position is held for 2-3 seconds before relaxing back to 20mmHg.
  • The test is then repeated in 2mmHg increments 
  • The test is stopped when abnormal activity is detected by the clinician which may include:
    • Palpable activity of SCM or AS.
    • Head retraction or head lifting.
    • Increased pressure on the PBFU without increased CCF movement.
    • Inability to relax to 20mmHg.

At the end of stage 1 you have gained a ?baseline of the muscle activity. You then move onto stage 2 which is a test of isometric endurance.

Test 2:

  • The test is commenced at the lowest level to see if the patient can hold 10 x 10 second isometric contractions at 22mmHg.
  • Then they can progress to the next level (24mmHg).
  • You should, document the activation score as the level of mmHg by the number of 10 second holds.

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